Knee replacement technology has patients on their feet faster

Monday

Mar 30, 2009 at 12:01 AMMar 30, 2009 at 3:11 PM

Traditional knee replacements forced surgeons to make all their decisions in the operating room, but a relatively new technology allows an orthopedist to know exactly where and how he’ll cut — weeks before going into surgery .

Jessica Scarpati

The scalpel slit open Gerald Good’s left knee from top to bottom. Dr. Stephen C. McNeil, in an operating room at Good Samaritan Medical Center in Brockton, surveyed the exposed knee joint. He could see its natural cushioning had worn away, which is what had brought the 76-year-old Randolph man to him a month earlier.

McNeil was there to replace not just this knee, but both of them with prosthetic implants to undo the stiffness and aching Good’s advanced arthritis had caused.

At this point in a traditional knee replacement surgery, the Easton orthopedist would be drilling a metal rod into the canals of the thigh and shin bones — to determine how he might cut them and fit the metal alloy knee.

In the days and weeks after the operation, pain and swelling from the drilling would haunt his patients. The recovery from the trauma of surgery would linger for months. Some would be in more pain than they were before the procedure.

But McNeil never did that kind of drilling during Good’s surgery in January — nor has he on 150 patients since late 2007, when he adopted a technology that changed the way knee replacement surgery is done at Good Samaritan Medical Center.

A small plastic block, no bigger than his palm, is the key to making the popular procedure safer and faster, with a swifter recovery with fewer complications, McNeil said.

The block is a customized cutting guide for the surgeon — based on the MRI scan of each patient’s knee, and then turned into a three-dimensional computer image.

That kind of blueprint — manufactured weeks before surgery by California-based company OtisMed — eliminates the need to drill into bone canals by showing the surgeon exactly where and how to cut, McNeil said.

“We used to have to do a lot more work in the OR,” he said. “It gives us more precision, and it’s less invasive.”

There would also be no guessing as to which of the eight sizes of implant Good would need that morning — something McNeil used to have to figure out in surgery. Using the same digital imagery, OtisMed determines that in advance, too.

The procedure is covered by insurance agencies like any other total knee replacement, said a company spokeswoman.

Better recovery

For most surgeries, the company said a double-knee replacement with OtisKnee should take 25 to 45 minutes, as compared to 60 to 90 minutes for the conventional method, depending on the surgeon.

Most patients also have shorter stays in the hospital after surgery and fewer transfer to a rehabilitation facility, McNeil said.

“Rehab starts right in the hospital,” he said, noting patients awaken with a machine bending their knee for them.

The company said average length of hospital stay for OtisKnee double knee replacement is two days — versus three to five with conventional methods.

McNeil said most of his OtisKnee patients stay for three days, versus 3.5 with the traditional method, because insurance carriers tend to allow an extra day of recovery since most people don’t need inpatient rehab.

All of this cuts the risk of complication and infection, he said.

“The key for us is just (to) trust in the technology,” McNeil said. “And I’ve got to tell you — it’s right.”

Traditional vs. new

Traditional knee replacements require orthopedic surgeons to make all their decisions while the patient is on the operating table — what size implant to use, where to cut the bone, how to shape the bone.

That caused more bleeding during surgery, more pain and swelling afterward and longer hospital stays, said McNeil, who is not paid by OtisMed.

Good Samaritan is among six hospitals in the greater Boston area with OtisKnee, and ranks third in New England in terms of volume, said company officials.

As of late March, the company reported about 16,000 OtisKnee cases since launching the technology. About 150 have been done at Good Sam.

Academic hospitals in Boston have been critical of OtisKnee and resistant to adopting the technology, saying it ignores the ankle and hip alignments in designing the knee surgery.

McNeil, who has performed more than 100 OtisKnee replacements, said his patients now recover faster and with fewer complaints.

“The patients will determine the outcome over time,” McNeil said. “If there’s a better way to do it, I’ll do it.”

When arthritis strikes

Stiffness, imbalance, pain and loss of movement from advanced arthritis are among the reasons patients come to McNeil.

With the large baby-boom generation nearing or entering the age when arthritis may strike, McNeil said he is seeing more patients. But younger patients also come in for consultations and surgery.

“They definitely want to stay active,” he said. “They just don’t want to put up with this bum knee for the rest of their lives.”

Pain wasn’t the key motivator for Good to undergo the surgery. As a longtime athlete, he has a high pain tolerance, but stiffness in his joints had disrupted his active lifestyle.

All the cartilage, an elastic tissue supposed to cushion his joints, had worn away with age. With each step Good took, bone was grinding against bone.

The OtisKnee method made sense to the retired businessman, who said he had no qualms about having major surgery at his age.

“I don’t feel like I’m 76,” Good said. “Why would I hesitate, knowing my problems were going to continue?”

During Good’s surgery, for which he was given spinal anesthesia, in 25 minutes one knee was replaced; in less than an hour, both. In three weeks, he was walking without any assistance — no crutches, no cane.

“The day is gone where people just put up with their joints,” McNeil said. “There are a lot more patients who are saying, ‘Why should I live my life like this?’”

Jessica Scarpati can be reached at jscarpati@enterprisenews.com.

Osteoarthritis

What it is: Chronic condition in which joint cartilage breaks down.

Where it hits: Typically the hips, hands, knee, lower back and neck.

Who has it: Nearly 27 million Americans, though after age 50 it’s seen more in women than men.

What it feels like: Pain or stiffness in joints after periods of inactivity or excessive use; grafting or “catching” sensation during joint movement; bony growths at the margins of affected joints.